Provider Demographics
NPI:1245578418
Name:BLANEY VISION CENTER LLC
Entity Type:Organization
Organization Name:BLANEY VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLANEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-664-8676
Mailing Address - Street 1:420 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1204
Mailing Address - Country:US
Mailing Address - Phone:814-664-8676
Mailing Address - Fax:814-664-8677
Practice Address - Street 1:420 N CENTER ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1204
Practice Address - Country:US
Practice Address - Phone:814-664-8676
Practice Address - Fax:814-664-8677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000646152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty